The year of cataclysm for the NHS

It has been a big year for the English health service, for the wrong
reasons. With so much happening so fast, Alex Nunns of the NHS Support
Federation pulls together the strands to explain what is really going on
in the NHS.

Image: Bankenstein

2012 will go down as a cataclysmic date in the history of the English
health service. It was the year when the virus of privatisation finally
gained control of the cell nucleus of the NHS and began its destruction
in earnest.

If you listen to the politicians you wouldn’t know it. According to David Cameron, “we will not be selling off the NHS.” If you believe Nick Clegg, “there will be no privatisation.”
They have been able to get away with this deception because the
transformation they unleashed is messy. It is happening everywhere, but
not uniformly. It is hidden by its very scale and spread.

But take a step back and the patterns are unmistakable. The controversial Health and Social Care Act passed in March 2012 ended the English National Health Service in all but name
by abolishing the 60-year duty on the government to provide
comprehensive healthcare for all. In its place is not so much a new
structure as a process with its own dynamic—that of a snowball tumbling
down a hillside.

With perfect symmetry, the private sector expects to win£20 billion of business from the NHS,
according to the corporate finance adviser Catalyst. Huge slices of the
health service are being awarded to the highest bidder. With remarkable
speed a few gluttonous companies—Virgin Care, Serco, Care UK—have
secured dominant positions in the market, gobbling up services from
Cornwall to Cumbria. The defenders of the reforms talk about competition
driving improvements, but already it is consolidation, not competition,
that we are seeing.

There may be a GP surgery near you that is now run by Virgin. Until
March 2012 Virgin Care did not exist, although it had been operating
under another name since 2010. It now runs at least 358 GP practices.
Behind the friendly PR façade of the bearded entrepreneur, patients see a
different face, cold and sinister. Take the Kings Heath Practice in
Northampton. Since Virgin took it over
from the NHS, patients have had to wait up to three weeks for an
appointment instead of three days, three GPs have been reduced to one,
and three nurses cut to one part-time nurse. When the single GP went on
leave, the surgery was staffed entirely by locums for five months. And
while the company boasts about the surgery’s opening hours, often there
are no clinicians present, just an open empty building. Locals complain
that Virgin has “brought Third World medical standards to Kings Heath.”

The biggest privatisations are taking place in community health
services. The government’s “any qualified provider” policy means whole
services must be subject to competition, leading to the demise of
NHS-run options. Local NHS bodies have already been instructed to outsource 39 types of service. Dubbed the “39 steps to privatisation,” this covers everything from autism care to wheelchair provision. Even publicly provided vasectomies are for the chop.

Not even hospitals offer shelter from the destructive gale blowing
through the NHS. Many Hospital Trusts are being pushed to the financial
brink by the disastrous legacy of the Private Finance Initiative
(PFI), under which new hospital building was financed by a deal that is
akin to paying by credit card, leaving Trusts with crippling debts to
the banks.

This has led to some Trusts literally going bankrupt, such as the
South London Healthcare Trust which serves over a million people in
three hospitals. Its PFI debts, like a black hole, have sucked in
surrounding hospitals and units, like Lewisham’s A&E department
which is now facing closure. Patients are left high and dry. As for the
Trust, it is to be carved up and offered piece by piece for privatisation, with the familiar vultures—Virgin, Serco, Care UK and Circle—picking at the remains.

Combine this with another controversial aspect of the Health and
Social Care Act—the ability for NHS hospitals to earn half their income
from private patients—and the implications are scary. A chilling
investigation by ITV’s Exposure program secretly filmed doctors assuring
a private patient that her money would buy priority over NHS patients
within the same hospital. It revealed
a tragic case where a consultant left half way through a dangerous
birth to carry out a private caesarean section. The baby later died. A
two-tier health system is not on the way; it is already here.

The drive for profit is insatiable, not least because many of the
dominant players in the new market are owned by ruthless private equity
firms. Similar funding models to that which led to the collapse of the Southern Cross care-home company
are now in the NHS. For example, Hospital Corporation of America, which
is entering into joint ventures with NHS hospitals, is majority owned
by three private equity firms including Mitt Romney’s notorious Bain Capital. It is hardly surprising, then, to see the use of tax havens and Starbucks-style tax avoidance
by the likes of Spire Healthcare, to take just one example, which
channels £65 million a year through Luxembourg, almost cancelling out
its taxable UK earnings.

All of this comes before the most high-profile part of the Health and
Social Care Act has even been fully implemented—the replacement of PCTs
with Clinical Commissioning Groups (CCGs). Sold to the public as
“giving power to GPs,” this transfers responsibility for spending £60
billion of public money to largely unaccountable new groups, who will in
turn outsource the work to privatised “commissioning support units”—allowing
the private sector to decide how taxpayers’ money is spent. If that
sounds complicated, it is. David Nicholson, the head of the health
service, fears it could end in “misery and failure.”

This is the reality of the new NHS: services and decision-making
privatised, hospitals reoriented towards making money, and treatments
withdrawn as the health service shrinks. The logical next step is
charging for treatments. Just think of how the dentist might offer a
standard filling on the NHS or a white “cosmetic” filling privately—both
options available from the same dentist in the same premises—and
imagine that occurring throughout the NHS. Except it will be more than
cosmetic. Already in Greenwich there has been an attempt to charge
appointment fees for podiatry, one of the outsourced community services
on the “39 steps.”

Andrew Lansley, the former health secretary, sacrificed his career to
get the Health and Social Care Act through. He was thanklessly moved
aside in September, but his name will not be forgotten. His replacement,
Murdoch-loving Jeremy Hunt, offers no relief, having personally intervened
to encourage a contract for Virgin Care in his constituency. As for
Labour, after its record in government of opening the way for
privatisation, it has changed tack in opposition, repeatedly pledging to
repeal the Act and scrap the market if elected—important commitments that it must be held to.

But the quantity of contracts currently being signed may take the NHS
over a tipping point, where the “facts on the ground” cannot be
reversed. That is why it is crucial to monitor, expose, slow and disrupt
the destruction of the NHS now, while there may still be time to save
it.

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